Research Article
BibTex RIS Cite

Can first trimester vitamin D levels predict adverse maternal outcomes in patients who do not take vitamin D supplements?

Year 2024, EARLY ONLINE, 1 - 8
https://doi.org/10.18621/eurj.1509016

Abstract

Objectives: Vitamin D deficiency is claimed to be associated with adverse perinatal outcomes. Here, we aimed to compare adverse maternal outcomes according to vitamin D levels and determine the predictive role of first-trimester vitamin D for adverse maternal outcomes in patients not receiving vitamin D supplementation.

Methods: This study was designed as a retrospective study. A total of 232 patients were divided into three groups: vitamin D deficient (n=127), vitamin D insufficient (n=57), and vitamin D sufficient group (n=48). Then, the vitamin D deficiency group was divided into severe (n=72) and mild (n=55) vitamin D deficiency. Sociodemographic characteristics, first-trimester vitamin D levels, and adverse maternal outcomes such as gestational diabetes mellitus, preeclampsia, preterm birth, and intrauterine growth restriction were compared between the groups. The predictive role of first-trimester vitamin D levels for adverse maternal outcomes was evaluated by ROC analysis.

Results: Gestational diabetes was more common in the vitamin D deficient group than in the vitamin D insufficient group (P=0.024). However, preeclampsia, preterm delivery, and composite adverse outcomes were more common in the vitamin D deficient group than in the vitamin D sufficient group (P=0.044, P=0.008, and P=0.023, respectively). There was no difference in maternal outcomes between the mild and severe vitamin D deficiency groups. First-trimester vitamin D levels ≤19 ng/mL predicted adverse outcomes with 73.2% sensitivity and 49.2% specificity (AUC=0.630, P=0.006).

Conclusions: We recommend screening vitamin D levels in the first trimester, especially in high-risk groups, due to the increased incidence of adverse outcomes. We believe that more research is needed to clarify the relationship between vitamin D and adverse outcomes and the effect of supplementation on these outcomes.

Ethical Statement

University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, local ethics committee (2024-TBEK 2024/06-10).

References

  • 1. Tahsin T, Khanam R, Chowdhury NH, et al. Vitamin D deficiency in pregnancy and the risk of preterm birth: a nested case-control study. BMC Pregnancy Childbirth. 2023;23(1):322. doi: 10.1186/s12884-023-05636-z.
  • 2. Lee SB, Jung SH, Lee H, et al. Maternal vitamin D deficiency in early pregnancy and perinatal and long-term outcomes. Heliyon. 2023;22;9(9):e19367. doi: 10.1016/j.heliyon.2023.e19367.
  • 3. Díaz L, Noyola-Martínez N, Barrera D, et al. Calcitriol inhibits TNF-alpha-induced inflammatory cytokines in human trophoblasts. J Reprod Immunol. 2009;81(1):17-24. doi: 10.1016/j.jri.2009.02.005.
  • 4. Grundmann M, von Versen-Höynck F. Vitamin D - roles in women's reproductive health? Reprod Biol Endocrinol. 2011;2(9):146. doi: 10.1186/1477-7827-9-146.
  • 5. Shin JS, Choi MY, Longtine MS, Nelson DM. Vitamin D effects on pregnancy and the placenta. Placenta. 2010;31(12):1027-1034. doi: 10.1016/j.placenta.2010.08.015.
  • 6. Wei SQ, Qi HP, Luo ZC, Fraser WD. Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2013;26(9):889-99. doi: 10.3109/14767058.2013.765849.
  • 7. Shand AW, Nassar N, Von Dadelszen P, Innis SM, Green TJ. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre-eclampsia. BJOG. 2010;117(13):1593-1598. doi: 10.1111/j.1471-0528.2010.02742.x.
  • 8. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-1503. doi: 10.1016/S0140-6736(01)06580-1.
  • 9. Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr. 2007;85(3):788-795. doi: 10.1093/ajcn/85.3.788.
  • 10. Zhang H, Wang S, Tuo L, et al. Relationship between Maternal Vitamin D Levels and Adverse Outcomes. Nutrients. 2022;14(20):4230. doi: 10.3390/nu14204230.
  • 11. Saraf R, Morton SM, Camargo CA Jr, Grant CC. Global summary of maternal and newborn vitamin D status - a systematic review. Matern Child Nutr. 2016;12(4):647-668. doi: 10.1111/mcn.12210.
  • 12. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 30. Clinical management guidelines for obstetrician-gynecologists. Gestational Diabetes. Washington DC: ACOG; 2001.
  • 13. Ni M, Zhang Q, Zhao J, et al. Relationship between maternal vitamin D status in the first trimester of pregnancy and maternal and neonatal outcomes: a retrospective single center study. BMC Pediatr. 2021;21(1):330. doi: 10.1186/s12887-021-02730-z.
  • 14. Kingdom J, Ashwal E, Lausman A, et al. Guideline No. 442: Fetal Growth Restriction: Screening, Diagnosis, and Management in Singleton Pregnancies. J ObstetGynaecol Can. 2023;45(10):102154. doi: 10.1016/j.jogc.2023.05.022.
  • 15. Abd Aziz NH, Yazid NA, Abd Rahman R, et al. Is First Trimester Maternal 25-Hydroxyvitamin D Level Related to Adverse Maternal and Neonatal Pregnancy Outcomes? A Prospective Cohort Study among Malaysian Women. Int J Environ Res Public Health. 2020;8:17(9):3291. doi: 10.3390/ijerph17093291.
  • 16. Jablonski KL, Chonchol M, Pierce GL, Walker AE, Seals DR. 25-Hydroxyvitamin D deficiency is associated with inflammation-linked vascular endothelial dysfunction in middle-aged and older adults. Hypertension. 2011;57(1):63-69. doi: 10.1161/HYPERTENSIONAHA.110.160929.
  • 17. Tarcin O, Yavuz DG, OzbenB, et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab. 2009;94(10):4023-4030. doi: 10.1210/jc.2008-1212.
  • 18. Evans KN, Bulmer JN, Kilby MD, Hewison M. Vitamin D and placental-decidual function. J Soc GynecolInvestig. 2004;11(5):263-271. doi: 10.1016/j.jsgi.2004.02.002.
  • 19. Magnus P, Eskild A. Seasonal variation in the occurrence of pre-eclampsia. BJOG. 2001;108(11):1116-1119. doi: 10.1111/j.1471-0528.2003.00273.x.
  • 20. Bodnar LM, Catov JM, Roberts JM. Racial/ethnic differences in the monthly variation of preeclampsia incidence. Am J Obstet Gynecol. 2007;196(4):324.e1-5. doi: 10.1016/j.ajog.2006.11.028.
  • 21. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-3522. doi: 10.1210/jc.2007-0718.
  • 22. Haugen M, Brantsaeter AL, Trogstad L, et al.Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology. 2009;20(5):720-726. doi: 10.1097/EDE.0b013e3181a70f08.
  • 23. Al-Shaikh GK, Ibrahim GH, Fayed AA, Al-Mandeel H. Impact of vitamin D deficiency on maternal and birth outcomes in the Saudi population: a cross-sectional study. BMC Pregnancy Childbirth. 2016;16:119. doi: 10.1186/s12884-016-0901-4.
  • 24. Vaidya A, Williams JS. Vitamin D and insulin sensitivity: can gene association and pharmacogenetic studies of the vitamin D receptor provide clarity? Metabolism. 2012;61(6):759-761. doi: 10.1016/j.metabol.2011.12.009.
  • 25. Eggemoen ÅR, Waage CW, Sletner L, Gulseth HL, Birkeland KI, Jenum AK. Vitamin D, Gestational Diabetes, and Measures of Glucose Metabolism in a Population-Based Multiethnic Cohort. J Diabetes Res. 2018;2018:8939235. doi: 10.1155/2018/8939235.
  • 26. Lu M, Xu Y, Lv L, Zhang M. Association between vitamin D status and the risk of gestational diabetes mellitus: a meta-analysis. Arch Gynecol Obstet. 2016;293(5):959-966. doi: 10.1007/s00404-016-4010-4.
  • 27. Wu C, Song Y, Wang X. Vitamin D Supplementation for the Outcomes of Patients with Gestational Diabetes Mellitus and Neonates: A Meta-Analysis and Systematic Review. Int J Clin Pract. 2023;2023:1907222. doi: 10.1155/2023/1907222.
  • 28. Wang M, Chen Z, Hu Y, et al. The effects of vitamin D supplementation on glycemic control and maternal-neonatal outcomes in women with established gestational diabetes mellitus: A systematic review and meta-analysis. Clin Nutr. 2021;40(5):3148-3157. doi: 10.1016/j.clnu.2020.12.016.
  • 29. Liu N, Kaplan AT, Low J, et al. Vitamin D induces innate antibacterial responses in human trophoblasts via an intracrine pathway. Biol Reprod. 2009;80(3):398-406. doi: 10.1095/biolreprod.108.073577.
  • 30. De-Regil LM, Palacios C, Lombardo LK, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2016;(1):CD008873. doi: 10.1002/14651858.CD008873.pub3.
  • 31. Bodnar LM, Platt RW, Simhan HN. Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Obstet Gynecol. 2015;125(2):439-447. doi: 10.1097/AOG.0000000000000621.
  • 32. Perez-Ferre N, Torrejon MJ, Fuentes M, et al. Association of low serum 25-hydroxyvitamin D levels in pregnancy with glucose homeostasis and obstetric and newborn outcomes. Endocr Pract. 2012;18(5):676-684. doi: 10.4158/EP12025.OR.
  • 33. Chien MC, Huang CY, Wang JH, Shih CL, Wu P. Effects of vitamin D in pregnancy on maternal and offspring health-related outcomes: An umbrella review of systematic review and meta-analyses. Nutr Diabetes. 2024;14(1):35. doi: 10.1038/s41387-024-00296-0.
  • 34. Monier I, Baptiste A, Tsatsaris V, et al. First Trimester Maternal Vitamin D Status and Risks of Preterm Birth and Small-For-Gestational Age. Nutrients. 2019;11(12):3042. doi: 10.3390/nu11123042.
  • 35. Flood-Nichols SK, Tinnemore D, Huang RR, Napolitano PG, Ippolito DL. Vitamin D deficiency in early pregnancy. PLoS One. 2015;10(4):e0123763. doi:10.1371/journal.pone.0123763.
  • 36. Baker AM, Haeri S, Camargo CA Jr, Stuebe AM, Boggess KA. A nested case-control study of first-trimester maternal vitamin D status and risk for spontaneous preterm birth. Am J Perinatol. 2011;28(9):667-672. doi: 10.1055/s-0031-1276731.
  • 37. Fernández-Alonso AM, Dionis-Sánchez EC, Chedraui P, González-Salmerón MD, Pérez-López FR. Spanish Vitamin D and Women's Health Research Group. First-trimester maternal serum 25-hydroxyvitamin D₃ status and pregnancy outcome. Int J Gynaecol Obstet. 2012;116(1):6-9. doi: 10.1016/j.ijgo.2011.07.029.
  • 38. Rodriguez A, García-Esteban R, Basterretxea M, et al. Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG. 2015;122(12):1695-1704. doi: 10.1111/1471-0528.13074.
  • 39. Wang S, Xin X, Luo W, et al. Association of vitamin D and gene variants in the vitamin D metabolic pathway with preterm birth. Nutrition. 2021;89:111349. doi: 10.1016/j.nut.2021.111349.
Year 2024, EARLY ONLINE, 1 - 8
https://doi.org/10.18621/eurj.1509016

Abstract

References

  • 1. Tahsin T, Khanam R, Chowdhury NH, et al. Vitamin D deficiency in pregnancy and the risk of preterm birth: a nested case-control study. BMC Pregnancy Childbirth. 2023;23(1):322. doi: 10.1186/s12884-023-05636-z.
  • 2. Lee SB, Jung SH, Lee H, et al. Maternal vitamin D deficiency in early pregnancy and perinatal and long-term outcomes. Heliyon. 2023;22;9(9):e19367. doi: 10.1016/j.heliyon.2023.e19367.
  • 3. Díaz L, Noyola-Martínez N, Barrera D, et al. Calcitriol inhibits TNF-alpha-induced inflammatory cytokines in human trophoblasts. J Reprod Immunol. 2009;81(1):17-24. doi: 10.1016/j.jri.2009.02.005.
  • 4. Grundmann M, von Versen-Höynck F. Vitamin D - roles in women's reproductive health? Reprod Biol Endocrinol. 2011;2(9):146. doi: 10.1186/1477-7827-9-146.
  • 5. Shin JS, Choi MY, Longtine MS, Nelson DM. Vitamin D effects on pregnancy and the placenta. Placenta. 2010;31(12):1027-1034. doi: 10.1016/j.placenta.2010.08.015.
  • 6. Wei SQ, Qi HP, Luo ZC, Fraser WD. Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2013;26(9):889-99. doi: 10.3109/14767058.2013.765849.
  • 7. Shand AW, Nassar N, Von Dadelszen P, Innis SM, Green TJ. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre-eclampsia. BJOG. 2010;117(13):1593-1598. doi: 10.1111/j.1471-0528.2010.02742.x.
  • 8. Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-1503. doi: 10.1016/S0140-6736(01)06580-1.
  • 9. Camargo CA Jr, Rifas-Shiman SL, Litonjua AA, et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr. 2007;85(3):788-795. doi: 10.1093/ajcn/85.3.788.
  • 10. Zhang H, Wang S, Tuo L, et al. Relationship between Maternal Vitamin D Levels and Adverse Outcomes. Nutrients. 2022;14(20):4230. doi: 10.3390/nu14204230.
  • 11. Saraf R, Morton SM, Camargo CA Jr, Grant CC. Global summary of maternal and newborn vitamin D status - a systematic review. Matern Child Nutr. 2016;12(4):647-668. doi: 10.1111/mcn.12210.
  • 12. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 30. Clinical management guidelines for obstetrician-gynecologists. Gestational Diabetes. Washington DC: ACOG; 2001.
  • 13. Ni M, Zhang Q, Zhao J, et al. Relationship between maternal vitamin D status in the first trimester of pregnancy and maternal and neonatal outcomes: a retrospective single center study. BMC Pediatr. 2021;21(1):330. doi: 10.1186/s12887-021-02730-z.
  • 14. Kingdom J, Ashwal E, Lausman A, et al. Guideline No. 442: Fetal Growth Restriction: Screening, Diagnosis, and Management in Singleton Pregnancies. J ObstetGynaecol Can. 2023;45(10):102154. doi: 10.1016/j.jogc.2023.05.022.
  • 15. Abd Aziz NH, Yazid NA, Abd Rahman R, et al. Is First Trimester Maternal 25-Hydroxyvitamin D Level Related to Adverse Maternal and Neonatal Pregnancy Outcomes? A Prospective Cohort Study among Malaysian Women. Int J Environ Res Public Health. 2020;8:17(9):3291. doi: 10.3390/ijerph17093291.
  • 16. Jablonski KL, Chonchol M, Pierce GL, Walker AE, Seals DR. 25-Hydroxyvitamin D deficiency is associated with inflammation-linked vascular endothelial dysfunction in middle-aged and older adults. Hypertension. 2011;57(1):63-69. doi: 10.1161/HYPERTENSIONAHA.110.160929.
  • 17. Tarcin O, Yavuz DG, OzbenB, et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab. 2009;94(10):4023-4030. doi: 10.1210/jc.2008-1212.
  • 18. Evans KN, Bulmer JN, Kilby MD, Hewison M. Vitamin D and placental-decidual function. J Soc GynecolInvestig. 2004;11(5):263-271. doi: 10.1016/j.jsgi.2004.02.002.
  • 19. Magnus P, Eskild A. Seasonal variation in the occurrence of pre-eclampsia. BJOG. 2001;108(11):1116-1119. doi: 10.1111/j.1471-0528.2003.00273.x.
  • 20. Bodnar LM, Catov JM, Roberts JM. Racial/ethnic differences in the monthly variation of preeclampsia incidence. Am J Obstet Gynecol. 2007;196(4):324.e1-5. doi: 10.1016/j.ajog.2006.11.028.
  • 21. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-3522. doi: 10.1210/jc.2007-0718.
  • 22. Haugen M, Brantsaeter AL, Trogstad L, et al.Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology. 2009;20(5):720-726. doi: 10.1097/EDE.0b013e3181a70f08.
  • 23. Al-Shaikh GK, Ibrahim GH, Fayed AA, Al-Mandeel H. Impact of vitamin D deficiency on maternal and birth outcomes in the Saudi population: a cross-sectional study. BMC Pregnancy Childbirth. 2016;16:119. doi: 10.1186/s12884-016-0901-4.
  • 24. Vaidya A, Williams JS. Vitamin D and insulin sensitivity: can gene association and pharmacogenetic studies of the vitamin D receptor provide clarity? Metabolism. 2012;61(6):759-761. doi: 10.1016/j.metabol.2011.12.009.
  • 25. Eggemoen ÅR, Waage CW, Sletner L, Gulseth HL, Birkeland KI, Jenum AK. Vitamin D, Gestational Diabetes, and Measures of Glucose Metabolism in a Population-Based Multiethnic Cohort. J Diabetes Res. 2018;2018:8939235. doi: 10.1155/2018/8939235.
  • 26. Lu M, Xu Y, Lv L, Zhang M. Association between vitamin D status and the risk of gestational diabetes mellitus: a meta-analysis. Arch Gynecol Obstet. 2016;293(5):959-966. doi: 10.1007/s00404-016-4010-4.
  • 27. Wu C, Song Y, Wang X. Vitamin D Supplementation for the Outcomes of Patients with Gestational Diabetes Mellitus and Neonates: A Meta-Analysis and Systematic Review. Int J Clin Pract. 2023;2023:1907222. doi: 10.1155/2023/1907222.
  • 28. Wang M, Chen Z, Hu Y, et al. The effects of vitamin D supplementation on glycemic control and maternal-neonatal outcomes in women with established gestational diabetes mellitus: A systematic review and meta-analysis. Clin Nutr. 2021;40(5):3148-3157. doi: 10.1016/j.clnu.2020.12.016.
  • 29. Liu N, Kaplan AT, Low J, et al. Vitamin D induces innate antibacterial responses in human trophoblasts via an intracrine pathway. Biol Reprod. 2009;80(3):398-406. doi: 10.1095/biolreprod.108.073577.
  • 30. De-Regil LM, Palacios C, Lombardo LK, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2016;(1):CD008873. doi: 10.1002/14651858.CD008873.pub3.
  • 31. Bodnar LM, Platt RW, Simhan HN. Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Obstet Gynecol. 2015;125(2):439-447. doi: 10.1097/AOG.0000000000000621.
  • 32. Perez-Ferre N, Torrejon MJ, Fuentes M, et al. Association of low serum 25-hydroxyvitamin D levels in pregnancy with glucose homeostasis and obstetric and newborn outcomes. Endocr Pract. 2012;18(5):676-684. doi: 10.4158/EP12025.OR.
  • 33. Chien MC, Huang CY, Wang JH, Shih CL, Wu P. Effects of vitamin D in pregnancy on maternal and offspring health-related outcomes: An umbrella review of systematic review and meta-analyses. Nutr Diabetes. 2024;14(1):35. doi: 10.1038/s41387-024-00296-0.
  • 34. Monier I, Baptiste A, Tsatsaris V, et al. First Trimester Maternal Vitamin D Status and Risks of Preterm Birth and Small-For-Gestational Age. Nutrients. 2019;11(12):3042. doi: 10.3390/nu11123042.
  • 35. Flood-Nichols SK, Tinnemore D, Huang RR, Napolitano PG, Ippolito DL. Vitamin D deficiency in early pregnancy. PLoS One. 2015;10(4):e0123763. doi:10.1371/journal.pone.0123763.
  • 36. Baker AM, Haeri S, Camargo CA Jr, Stuebe AM, Boggess KA. A nested case-control study of first-trimester maternal vitamin D status and risk for spontaneous preterm birth. Am J Perinatol. 2011;28(9):667-672. doi: 10.1055/s-0031-1276731.
  • 37. Fernández-Alonso AM, Dionis-Sánchez EC, Chedraui P, González-Salmerón MD, Pérez-López FR. Spanish Vitamin D and Women's Health Research Group. First-trimester maternal serum 25-hydroxyvitamin D₃ status and pregnancy outcome. Int J Gynaecol Obstet. 2012;116(1):6-9. doi: 10.1016/j.ijgo.2011.07.029.
  • 38. Rodriguez A, García-Esteban R, Basterretxea M, et al. Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG. 2015;122(12):1695-1704. doi: 10.1111/1471-0528.13074.
  • 39. Wang S, Xin X, Luo W, et al. Association of vitamin D and gene variants in the vitamin D metabolic pathway with preterm birth. Nutrition. 2021;89:111349. doi: 10.1016/j.nut.2021.111349.
There are 39 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Original Articles
Authors

Burcu Dinçgez 0000-0002-2697-7501

Gülten Özgen 0000-0002-7888-7583

Levent Özgen 0000-0003-0070-2646

Early Pub Date August 6, 2024
Publication Date
Submission Date July 6, 2024
Acceptance Date August 4, 2024
Published in Issue Year 2024 EARLY ONLINE

Cite

AMA Dinçgez B, Özgen G, Özgen L. Can first trimester vitamin D levels predict adverse maternal outcomes in patients who do not take vitamin D supplements?. Eur Res J. Published online August 1, 2024:1-8. doi:10.18621/eurj.1509016

e-ISSN: 2149-3189 


The European Research Journal, hosted by Turkish JournalPark ACADEMIC, is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

by-nc-nd.png

2024